Provider Demographics
NPI:1619450863
Name:WHIPPLE, KRYSTAL ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:ANN
Last Name:WHIPPLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:ANN
Other - Last Name:ASHCROFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:601 S RANCHO DR STE A10
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4898
Mailing Address - Country:US
Mailing Address - Phone:702-437-4673
Mailing Address - Fax:
Practice Address - Street 1:2851 JOE DIMAGGIO BLVD STE 7
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-3928
Practice Address - Country:US
Practice Address - Phone:512-763-2186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV171W00000X, 101YP2500X, 101YM0800X, 1041C0700X, 106H00000X
TX1121611041C0700X
NV10737-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171W00000XOther Service ProvidersContractor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist